Provider Demographics
NPI:1891790838
Name:TRUITT, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:TRUITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 WILBORN AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1662
Mailing Address - Country:US
Mailing Address - Phone:434-572-5260
Mailing Address - Fax:434-575-0862
Practice Address - Street 1:504 WILBORN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3120
Practice Address - Country:US
Practice Address - Phone:434-572-6935
Practice Address - Fax:434-572-4827
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010546332084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007107072Medicaid
VA89150OtherSENTARA
VA435519OtherANTHEM
VA435519OtherANTHEM
VA007107072Medicaid